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Lecture notes Acute Care (SHN2004)
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Care of the Child with Gastroenteritis
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SHN2004 (Acute Care) Care of the Child with GastroenteritisCare of the child with Gastroenteritis
Overview
Aim:
o For the student to develop an understanding of the care and management of
a child presenting with acute gastroenteritis.
Objectives - By the end of this session the student will be able to:
o Apply the chain of infection to the care and management of a child
presenting with acute gastroenteritis.
o Analyse causal factors leading to a diagnosis of acute gastroenteritis in
children.
o Identify ‘red flags’ in the care and management of acute gastroenteritis.
o Explain rehydration management of a child presenting with acute
gastroenteritis.
o Articulate advice to parents on the care of a child with gastroenteritis prior to
discharge home.
o Understand overall care and management of a child presenting with acute
gastroenteritis.
Chain of Infection
Susceptible Host
o Immunosuppressed individuals
o Open wound
o Premature babies
o Children
(generally)
Infectious agent –
Bacterial/viral/parasite
o E-coli
o Salmonella
Reservoir
o Entering the body
and the
gastrointestinal
tract
Portal of Exit –
vomiting/diarrhoea
Means of transmission – air/hand to mouth
o (Vapour contact)
Read the following scenario
1
, SHN2004 (Acute Care) Care of the Child with Gastroenteritis
Lola is a 6 month old girl, originally born at 32 weeks gestation, and was classified as
IUGR. She spent 10 weeks in a local SCBU. She been exclusively breastfed and
parents have just begun to be wean her. She has an older brother (Tommy, aged 3)
who attends a local nursery, but he has been off nursery within the last week due to
a ‘tummy bug’ which has caused D&V.
Lola has become unwell over the last 24 hours, with vomiting (3x episodes), 6
offensive smelling, ‘watery’ nappies and she is also not tolerating breast feeding very
well at the moment, she seems to have some abdominal discomfort prior to passing
stool. Parents report she seems drowsy, more so than normal.
The GP has referred Lola to the local PAU, and you are the nurse on duty.
What do you need to do?
o Chain of infection – cubicle nursing
o Airway could be compromised due to vomiting
o Breathing could be comprised due to aspiration
o Circulation
Fluid Balance – dehydration
o Disability
Consider Sepsis
Pain scale
Glasgow Coma Scale as she is drowsy
o Exposure
How has she become so ill
o Consider Sepsis
o Pain scale
o Glasgow Coma Scale as she is drowsy
o Stool Sample – to identify the particular strain (depends on situation)
o Monitor for signs of shock – seriously unwell child
What do you need to know?
o When did she last feed, for how long for – as she is breastfeeding is it a good
latch etc.
o Family history – who else has been ill and for how long for
o Medical History – she was born premature – any continuing problems?
o Has she started on solids – if so what
How does the chain of infection apply in this case?
o Hand hygiene – ask parents have they been washing their hands in every
occasion
o If eating solid – what food, how has it been prepared etc.
Gastroenteritis
It is a common acute childhood illness.
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